Early Departure Notification
Use this form if you are currently at work and need to leave early. Please first notify management of your need to leave and submit this form while still at work. Excused and Unexcused Absences as outlined in the Attendance Policy will apply. Accrued paid sick leave will be applied toward absences due to illness.
Name
*
First Name
Last Name
E-mail
*
example@example.com
Type of Absence
*
Illness or Injury
Other - Excused and Unexcused Absences as outlined in the Attendance Policy will apply.
Date of Missed Work
*
-
Month
-
Day
Year
Date
Anticipated Return to Work Date. (If unknown, list next scheduled work date and return to complete form again if more time needed.)
*
-
Month
-
Day
Year
Date
Please describe the reason for your early departure.
*
Submit
Should be Empty: